When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Friday, May 13, 2016

In the hospice segment our team
has made terrific progress on the challenging reorganization we've
undertaken over the past three years. We have seen significant
stabilization over the back half of 2015 and this quarter we saw the
first quarter of year-over-year census growth since our acquisition of
Gentiva with patient days increasing 2.9% year-over-year.

Not said: Patient days actually fell from Q4 2015

This growth
comes despite average length of stay decreasing by three days and branch
network consolidation reducing the number of hospice sites from 193, at
the beginning of 2015, to 175 at the beginning of 2016.

Not said: Admissions increased by 70 from Q1 2015 With 177 hospice sites that's an increase of 0.4 of an admission per site. Average daily census rose by 223 for the hospice segment or an additional 1.25 patients per day census wise for each site.

Average hospice revenue per branch grew more than 8% between the first
quarter of 2015 and the first quarter of 2016.

Not said: Less branches and stable revenues will do that. Hospice revenues decreased by $1.8 million from Q4 and are the lowest full quarter since Kindred bought Gentiva.

We expect to see
continued hospice growth driven by demographics as well as expected
enhanced hospice utilization rates. We also look to expand our hospice
presence with tuck-in acquisitions in markets not yet adequately covered
by our existing branch network.

So far this year we have acquired hospice operations in North Carolina,
Ohio and Florida. We're pleased with the margin improvement in our home
health and hospice businesses as they each provided on a year-over-year
basis up by nearly 1% when last year's quarter is appropriately
adjusted on a pro forma basis to include January.

Not said: Part of that Q1 margin improvement came from health care and retirement benefit reductions for former Gentiva employees.

I am glad to do my part to make our hospice more successful in care delivery. My hospice co-workers and I don't want to personally sacrifice to enrich senior executives. Q1 included $38 million in incentive payments to Kindred at Home executives and a relative handful of other employees. Their bonuses alone ate up 21.5% of our first quarter hospice revenue. That is evidence of the distortion from above. It can't be called leadership. It's far too selfish.

Tuesday, May 10, 2016

WDRBreported on the lawsuit saga for three neighbors who fought over a shared driveway, amongst other things. The three share a historic property just outside Louisville, Kentucky. All were relatively new owner of their respective properties, which included a permanent access easement for the shared driveway.

Mr. Fenley's lawsuit expressed a number of concerns with Mr. Farber's contractors which caused him to offer to build a separate drive for his neighbors. Fenley and Haynes prevailed in stopping the building of a new driveway. Their legal stance expressed a number of concerns about Fenley's proposal, including increased difficulty with stormwater control, the removal of large mature trees that were part of a former owner's landscape design and the loss of an aesthetically pleasing entrance.

On December 1, 2015 the parties attempted to mediate their conflict without success. Oddly, Mr. Farber's employer Kindred Healthcare had their in house attorney attend the personal mediation. The Fenley amended complaint stated Kindred had plats and survey drawings of all three properties drawn up. That's a high amount of employer involvement in an executive's personal dispute

This mediation occurred less than a week after Kindred Healthcare gave Mr. Farber an additional $250,000 for "moving expenses." (Generic Hospice reported on this development November 26, 2015.)

On December 18, 2015 a division of Kindred Healthcare purchased Mr. Farber's home for $2.15 milion. Farber paid $1.7 million for the home before embarking on a $200,000 + renovation which upset his neighbor.

On December 30, 2015 Kindred began removing the very trees Farber argued to preserve the historic landscape design. Mr. Fenley asserts in doing so, Kindred damaged his property.

The Fenley complaint has a number of tidbits that color the deterioration of neighborly relations. It reads of strong willed people wanting to have their way. There is little evidence of civility or the ability to come to conflict resolution in a neighborly manner. They could not come to resolution with highly paid mediation lawyers.

Yet, Kindred's Board of Directors chose to take two highly unusual acts. First, they gave Farber $250,000, on top of the original $110,000 in moving expenses for 2014. Second, the board bought his house for a premium price then took an action that Farber legally fought against with the aid and support of Kindred's legal counsel and contractors.

One Kindred employee received $360,000 in moving expenses in twenty one months. We have hospice employees who it will take nearly fifteen years to make in wages Farber's Kindred moving benefit.

It's good WDRB reported on the story. It's sad priorities are skewed for executives lacking the basic skills to resolve conflict. Frankly, we see the same distortions at our local hospice site.